Morphine: Difference between revisions
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==Adult Dosing== | ==Adult Dosing== | ||
* Acute pain (Moderate to severe): | *Acute pain (Moderate to severe): | ||
** Oral: 10-30 mg q4hr prn | **Oral: 10-30 mg q4hr prn | ||
** IM: 5-15mg q4hr prn | **IM: 5-15mg q4hr prn | ||
** IV: 2.5-5mg q3hr prn | **IV: 2.5-5mg q3hr prn | ||
*** AMI: 4-8mg q5-15min prn | ***AMI: 4-8mg q5-15min prn | ||
*** Critically ill: 2-4mg q1-2hr or 4-8mg q3-4hr prn | ***Critically ill: 2-4mg q1-2hr or 4-8mg q3-4hr prn | ||
** Continuous infusion IV, SC: 0.8-10mg/hr (up to 80mg/hr) | **Continuous infusion IV, SC: 0.8-10mg/hr (up to 80mg/hr) | ||
*** Critically ill: 2-30mg/hr | ***Critically ill: 2-30mg/hr | ||
*** PCA 0.5-2.5mg q5-10min prn | ***PCA 0.5-2.5mg q5-10min prn | ||
** Epidural (Preservative free) | **Epidural (Preservative free) | ||
*** Single dose: 30-100mcg/kg | ***Single dose: 30-100mcg/kg | ||
*** Continuous infusion: 0.2-0.4mg/hr | ***Continuous infusion: 0.2-0.4mg/hr | ||
*** Continuous microinfusion: 3.5-10mg over 24hrs, titrate to effect (max ~30mg) | ***Continuous microinfusion: 3.5-10mg over 24hrs, titrate to effect (max ~30mg) | ||
** Intrathecal (Preservative free) | **Intrathecal (Preservative free) | ||
*** Single dose: 0.1-03.mg | ***Single dose: 0.1-03.mg | ||
*** Continuous microinfusion: 0.2-10mg over 24 hours (max ~20mg) | ***Continuous microinfusion: 0.2-10mg over 24 hours (max ~20mg) | ||
** Rectal: 10-20mg q3-4hr | **Rectal: 10-20mg q3-4hr | ||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
* Children >6months and <50kg | *Children >6months and <50kg | ||
* Acute pain (Moderate to severe) | *Acute pain (Moderate to severe) | ||
** Oral: 0.15-0.3mg/kg q3-4hr prn | **Oral: 0.15-0.3mg/kg q3-4hr prn | ||
** IM, SC: 0.1-0.2mg/kg | **IM, SC: 0.1-0.2mg/kg | ||
** IV: 0.05-0.3mg/kg q3-4hr prn (not to exceed 10mg/dose) | **IV: 0.05-0.3mg/kg q3-4hr prn (not to exceed 10mg/dose) | ||
** Continuous infusion: 10-30mcg/kg/hr | **Continuous infusion: 10-30mcg/kg/hr | ||
** PCA 0.01-0.03mg/kg/dose and 0-0.03mg/kg/hr | **PCA 0.01-0.03mg/kg/dose and 0-0.03mg/kg/hr | ||
==Special Populations== | ==Special Populations== | ||
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*Lactation: Enters breast milk | *Lactation: Enters breast milk | ||
*Renal Dosing | *Renal Dosing | ||
** CrCl 10-50: 75% of normal dose | **CrCl 10-50: 75% of normal dose | ||
** CrCl <10: 50% of normal dose | **CrCl <10: 50% of normal dose | ||
** HD: Child 50%, adult no adjustment | **HD: Child 50%, adult no adjustment | ||
** PD: Child 50% | **PD: Child 50% | ||
** CRRT: Child and adults 75% | **CRRT: Child and adults 75% | ||
*Hepatic Dosing: No adjustment generally (cirrhosis can consider dose adjustment) | *Hepatic Dosing: No adjustment generally (cirrhosis can consider dose adjustment) | ||
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==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
* Circulatory depression, shock, cardiac arrest | *Circulatory depression, shock, cardiac arrest | ||
* Bradycardia, hypotension | *Bradycardia, hypotension | ||
* CNS depression, sedation | *CNS depression, sedation | ||
* Apnea, respiratory arrest/depression | *Apnea, respiratory arrest/depression | ||
* Anaphylaxis, laryngospasm | *Anaphylaxis, laryngospasm | ||
===Common=== | ===Common=== | ||
* Dependence | *Dependence | ||
* ADH release, hypogonadism | *ADH release, hypogonadism | ||
* Drowsiness, dizziness, confusion, headache | *Drowsiness, dizziness, confusion, headache | ||
* Pruritis | *Pruritis | ||
* Xerostomia, constipation, vomiting | *Xerostomia, constipation, vomiting | ||
* Urinary retention | *Urinary retention | ||
* Pancytopenia | *Pancytopenia | ||
* Weakness | *Weakness | ||
* Hypoxia | *Hypoxia | ||
* Histamine release, urticaria | *Histamine release, urticaria | ||
* Afib, tachycardia, edema, chest pain | *Afib, tachycardia, edema, chest pain | ||
* Abdominal pain | *Abdominal pain | ||
==Pharmacology== | ==Pharmacology== | ||
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*Excretion: Urine and feces | *Excretion: Urine and feces | ||
*Mechanism of Action: | *Mechanism of Action: | ||
** Binds to opioid receptors in CNS | **Binds to opioid receptors in CNS | ||
** Inhibits ascending pain pathways | **Inhibits ascending pain pathways | ||
** Alters perception and response to pain | **Alters perception and response to pain | ||
** Produces CNS depression | **Produces CNS depression | ||
==See Also== | ==See Also== | ||
| Line 83: | Line 83: | ||
<references/> | <references/> | ||
[[Category:Pharmacology]] | [[Category:Pharmacology]] | ||
* UpToDate | *UpToDate | ||
Revision as of 13:40, 4 July 2016
General
- Type: Opiods
- Dosage Forms: 5, 10, 15, 20, 30, 45, 50, 60, 75, 80, 90, 100, 120, 200, 0.5/ml, 1/ml, 2/ml, 4/ml. 5/ml, 8/ml, 10/ml, 15/ml, 25/ml, 50/ml,
- Common Trade Names: Astramorph, AVINza, Duramorph, Infumorph, Kadian, MS contin
Adult Dosing
- Acute pain (Moderate to severe):
- Oral: 10-30 mg q4hr prn
- IM: 5-15mg q4hr prn
- IV: 2.5-5mg q3hr prn
- AMI: 4-8mg q5-15min prn
- Critically ill: 2-4mg q1-2hr or 4-8mg q3-4hr prn
- Continuous infusion IV, SC: 0.8-10mg/hr (up to 80mg/hr)
- Critically ill: 2-30mg/hr
- PCA 0.5-2.5mg q5-10min prn
- Epidural (Preservative free)
- Single dose: 30-100mcg/kg
- Continuous infusion: 0.2-0.4mg/hr
- Continuous microinfusion: 3.5-10mg over 24hrs, titrate to effect (max ~30mg)
- Intrathecal (Preservative free)
- Single dose: 0.1-03.mg
- Continuous microinfusion: 0.2-10mg over 24 hours (max ~20mg)
- Rectal: 10-20mg q3-4hr
Pediatric Dosing
- Children >6months and <50kg
- Acute pain (Moderate to severe)
- Oral: 0.15-0.3mg/kg q3-4hr prn
- IM, SC: 0.1-0.2mg/kg
- IV: 0.05-0.3mg/kg q3-4hr prn (not to exceed 10mg/dose)
- Continuous infusion: 10-30mcg/kg/hr
- PCA 0.01-0.03mg/kg/dose and 0-0.03mg/kg/hr
Special Populations
- Pregnancy Rating: C
- Lactation: Enters breast milk
- Renal Dosing
- CrCl 10-50: 75% of normal dose
- CrCl <10: 50% of normal dose
- HD: Child 50%, adult no adjustment
- PD: Child 50%
- CRRT: Child and adults 75%
- Hepatic Dosing: No adjustment generally (cirrhosis can consider dose adjustment)
Contraindications
- Allergy to class/drug
Adverse Reactions
Serious
- Circulatory depression, shock, cardiac arrest
- Bradycardia, hypotension
- CNS depression, sedation
- Apnea, respiratory arrest/depression
- Anaphylaxis, laryngospasm
Common
- Dependence
- ADH release, hypogonadism
- Drowsiness, dizziness, confusion, headache
- Pruritis
- Xerostomia, constipation, vomiting
- Urinary retention
- Pancytopenia
- Weakness
- Hypoxia
- Histamine release, urticaria
- Afib, tachycardia, edema, chest pain
- Abdominal pain
Pharmacology
- Half-life: Immediate release 2-4hrs; Avinza 24hrs; Kadian 11-13hrs
- Metabolism: Hepatic
- Excretion: Urine and feces
- Mechanism of Action:
- Binds to opioid receptors in CNS
- Inhibits ascending pain pathways
- Alters perception and response to pain
- Produces CNS depression
See Also
References
- UpToDate